Good intentions
Forum Replies Created
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My impression was affected quite a bit by a presentation he gave at a SAGES meeting. I created a Topic about it. I do try to be open-minded but what I often see seems to be efforts to rationalize the state of hernia repair today. I do think that Dr. Orenstein’s first inclination would be to suggest mesh implantation for even the simplest hernia. He might offer a pure tissue repair but he would probably recommend a mesh repair. That is my impression.
Here is a link to that other thread. Feel free to correct my impressions, I won’t be offended. The first few minutes should be enough. He even jokes about the problem.
https://herniatalk.com/forums/topic/mesh-is-it-the-cause-of-the-problem-sages-2019/
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Thanks for the discussion Mark T. I wrote a bunch then realized I was just rehashing things that I’ve already said many times.
It is interesting to imagine that maybe the focus on people with pre-existing psychosocial problems could lead the hernia repair community to make better choices overall. What if they decide/realize that a pure tissue repair is the best choice for a person with pre-existing psychosocial issues, because potentially subjecting a person in a weakened mental state to the years of complications from mesh could drive them over the edge. Today’s thought seems to be that it’s okay to subject healthy people to that risk. The risks and complications are clear but they do it anyway. Maybe they’ll realize that subjecting weakened people to that risk is not “right”.
It’s a double-edged sword though. The realization could result in the holding back of care for people with psychosocial issues, because the logical extension to healthy people won’t fit the paradigm. When I first saw Dr. Ramshaw’s comments on the subject my first thought was that they were developing a screening tool to reject patients that might be a problem in the future if they developed CPIP. Reject care because they might complain.
In these types of conversations I haven’t seen the proposal of how to handle the people with psychological problems, to get their hernia repaired in a way that is best for the patient. The efforts seem to be on identifying the correlation, but it’s not clear what they will do afterward.
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When I click on the link I see that Columbia Comprehensive Hernia Center comes right up. So, not hidden like I suggested. They do seem to have changed their name though, adding the word Comprehensive. You have to assume that the two names are for the same institution. I guess if you’ve been attending the summit for 13 years you already knew.
Apparently, the Center is part of the Columbia University system. Always good to know how an organization works.
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Here is the web site of the organization running the show – https://cine-med.com/
And a link to the Columbia Hernia Center, who apparently hired CineMed to do the work.
https://columbiasurgery.org/hernia
You can’t find the word “comprehensive” used until you get to a different page. I assume it’s them but there’s no link on the Summit page site. Interesting how these meetings pop up but you can’t really see who is behind them.
https://columbiasurgery.org/conditions-and-treatments/hernia
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Hope for the best, plan for the worst. I had the opposite feeling – get the benefits of his knowledge while he is still available.
Who is coming through today’s system that will be better? His colleague at OHSU, D. Orenstein, is very firmly in the mesh camp. When all you know is mesh everything looks like a mesh application.
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I found the member, she is mamadunlop. Also, apparently, Dr. Martindale has been on HerniaTalk LIVE on Youtube.
Click on Activity and you can see her old posts.
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Dr. Martindale at OHSU might be worth talking to. From what I’ve seen he is open-minded and takes on very difficult abdominal problems, both mesh-related and not. He is a bit older so has seen the rise of problems and probably knows more than a typical new surgeon of today who was never trained in how to perform a pure tissue repair.
Unfortunately OHSU tends to have a very long wait time to get in to see anyone. Worth a shot though. There is a forum member who has seen Dr. Martindale and might have some insight. I’ll see if I can find her posts.
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JamesDoncaster you are the second person that I know of, for whom Dr. Wright removed the very mesh that he had implanted. In the other case the person just could not stand the feeling of the mesh inside his body and had it removed within months of implantation. I don’t remember the details of your case, if you had posted them. I’ll have to look.
I wonder how Dr. Wright justifies implanting mesh then removing the same mesh that he had implanted. What changes does he make to his method to avoid performing two surgeries on the same patient, leaving them worse off than when they came to see him?
I realize that I have completely flipped sides, first recommending Dr. Wright, now criticizing him. The rationale behind what’s going on in the hernia repair field doesn’t seem consistent with logic. It’s all very strange.
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Here is the performance paper. From the military.
It assesses repair methods and the ability to get back to military duty quickly. An issue that seems very important and relevant to the military. Understanding how to get the troops back in action as soon as possible. I’ve often though that lap mesh repair was ideal for this purpose. Worry about the problems after the war is won. But, they did not come to that conclusion. Open and lap gave the same results. Note that “hernioplasty” means mesh is used, by definition.
They only assessed physical performance, apparently. Although mental and emotional states are also very important for members of the military. The paper seems very “old school”. A vision of General Patton comes to mind.
https://link.springer.com/article/10.1007/s10029-022-02650-6
“Purpose
The advantages of minimally invasive inguinal hernia repair (MIHR) over open hernia repair (OHR) continue to be debated. We compared MIHR to OHR by utilizing the Army Physical Fitness Test (APFT) as an outcome measure.”“Conclusion
Overall, no differences in post-operative APFT scores, military profile time, or time to first post-operative APFT were observed between minimally invasive or open hernioplasty in this military population.” -
You might try Dr. Andrew Wright at UW Medicine. Although he is a mesh proponent he also removes mesh so is aware of the issues. If he doesn’t feel confident in his own skills he probably knows somebody that is good.
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The link in Dr. Towfigh’s post does not bring up the whole thread.
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No offense intended William Bryant. It’s easy to get misled.
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They also combined alcohol and tobacco in to one group. Tobacco usage is well known to cause problems with healing. And they could easily have shown each patient’s individual data. 15 tissue samples is easily manageable. No need to combine them. One outlier could easily skew the results of the other four. It’s just a bad paper.
It looks like a study done to prove an “idea”, a guess, rather than to learn a truth. There is a lot of that out there.
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Fifteen patients in that study. That’s a terrible attempt at a scientific study. It’s worthless. There is a lot of bad science in the field of medicine. You have to be careful about what you read and dig deep in to the why and the how of the publications.
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Also found the original thread.
https://herniatalk.com/forums/topic/marcy-repair-in-adults-with-inguinal-hernia/
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I found an old comment from Dr. Kang and Chaunce1234 that includes Dr. Ponsky’s method.
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It might be worthwhile to contact Dr. Ponsky. He showed good results for his laparoscopic pure tissue technique all the way up to patients aged 41 years. If you have weak tissue it’s going to affect any type of pure tissue repair.
https://herniatalk.com/forums/topic/laparoscopic-non-mesh-hernia-repair-todd-ponsky/
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Even in open no-mesh surgery there are different methods. Some cut nerves and some don’t.
Can you give more details about the method used? And the type of hernia?
I don’t have any experience in your type of problem. Just mesh implantation and removal, both laparoscopic. Healing can take quite a while. I found at times that more activity actually helped the pain, rather than rest. You might experiment and see if the pain stays constant, gets worse, or maybe gets better, with increased activity. It seems counterintuitive but physiologically I think it makes sense. The damaged tissue needs good fluid movement to resupply the tissues with oxygen and remove damaged materials. New blood vessels need to grow in to restore the balance.
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I don’t think that running increases the odds of getting a hernia. Certain types of lifting do though, I think. Using the Valsalva maneuver to lift more weight for example.
Since Dr. Belyansksy is primarily a laparoscopic mesh implanting surgeon you’ll want to find out what pure tissue method he uses and what his results are. He probably has a small number to work from though. You might ask him if he has a recommendation for a surgeon for a pure tissue repair. Who knows, he might be more confident in someone else’s skills in that area.
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Thank you for the effort Dr. Towfigh. But the rest of the thread contents are missing, only the first post comes up through your link. This first post has already been linked above, by yourself. There were many replies to Dr. Sea’s Topic, close to 20 I think, a full and detailed conversation. Dr. Sea’s account might be restored but the thread is not.
Your server should still contain all of the replies to Dr. Sea’s thread. Your IT person should be able to resurrect the complete thread very easily.